No Easy Answers in Bioethics Podcast

Plastic Surgeons on Snapchat: Stahl and Vercler - Episode 10

November 8, 2018

Would you ever consent to have your medical procedure broadcast on social media? This episode addresses a trend known as Snapchat surgeons – plastic surgeons who amass sometimes millions of followers on the social media platform Snapchat by posting uncensored videos of operations they are performing. These videos are often highly stylized, comedic, and meant to entertain.

Guests Dr. Devan Stahl, Assistant Professor in the Center for Ethics and the Department of Pediatrics and Human Development, and Dr. Christian Vercler, Clinical Associate Professor of Plastic Surgery in the Department of Surgery at the University of Michigan and Co-Chief of the Clinical Ethics Service in the Center for Bioethics and Social Sciences in Medicine, have published research on the subject, most notably in the AMA Journal of Ethics in April of this year. Together they offer their insight and expertise on the issue, and discuss whether these Snapchat performances are ethical. They also delve into the societal norms and power dynamics at play, and address how to move forward within the profession of plastic surgery in a world where social media seems to be here to stay.

This episode was produced and edited by Liz McDaniel in the Center for Ethics. Music: "While We Walk (2004)" by Antony Raijekov via Free Music Archive, licensed under a Attribution-NonCommercial-ShareAlike License.

Bennett KG, Berlin NL, MacEachern MP, Buchman SR, Preminger BA, Vercler CJ. “The Ethical and Professional Use of Social Media in Surgery: A Systematic Review of the Literature.” Plastic and Reconstructive Surgery. September 2018;142(3):388e-398e. ncbi.nlm.nih.gov/pubmed/30148789.

Episode Transcript

Liz McDaniel: Hello and welcome to another episode of No Easy Answers in Bioethics, the podcast from the Center for Ethics and Humanities in the Life Sciences at the Michigan State University College of Human Medicine. We are back after a bit of a hiatus between seasons, and we’re starting season two today with an episode on Snapchat surgeons – plastic surgeons who amass sometimes millions of followers on the social media platform Snapchat by posting uncensored video of operations they are performing in a way that is often highly stylized, comedic, and meant to entertain. Guests Dr. Devan Stahl from the Center for Ethics and Dr. Christian Vercler from the University of Michigan have published research on the subject, most notably in the AMA Journal of Ethics in April of this year. Together they offer their insight and expertise on the issue, and discuss whether these Snapchat performances are ethical. They also delve into the societal norms and power dynamics at play, and address how to move forward within the profession of plastic surgery in a world where social media seems to be here to stay.

Devan Stahl: My name is Devan Stahl, I'm an assistant professor of clinical ethics here at Michigan State University in the Center for Ethics and Humanities in the Life Sciences.

Christian Vercler: I'm Christian Vercler, I'm an associate professor of plastic surgery, I also have an appointment in the Center for Bioethics and Social Sciences in Medicine at the University of Michigan.

DS: Thanks, Christian. So, we got together because you introduced me to this super interesting topic, in the realm of surgical ethics, that I was completely unaware of. And we wrote this great paper that everyone should check out after the podcast through the AMA Journal of Ethics. But, maybe Christian you could tell me how you first heard about this topic of Snapchat surgeons.

CV: Yeah, so I'm a plastic surgeon at the University of Michigan, and so you can imagine what we do is pretty, uh, ivory tower. Some people would say that I'm out of touch with what the everyday plastic surgeon does. And, I really had no idea about what was going on with people, plastic surgeons using social media. And one of my nurses let me know that a former trainee of our institution had a Snapchat, I guess channel, or he was on Snapchat, and he was posting all sorts of videos of him performing operations. And he also had kind of a shtick that he would do. And the one that she first showed me was him dressed up as Prince Charming, singing "when you wish upon a star your dreams come true," and it was him dressed as Prince Charming and the patient, that was a princess lying on the operating room table, and then it cut to a woman's breast that had been augmented. And that was pretty shocking. And, uh, I was pretty shocked, and said, I gotta show people this because this is something that's sort of crazy, um, I can't imagine that this is something that really exists out there and that my colleagues in plastic surgery are doing.

DS: Yeah, absolutely. So, when you started showing me this, I also had that same reaction of like, wow, I can't believe people are doing this. It's so performative, it's so intimate, it's so revealing. It's just a lot of things. And, you know, this is a podcast, people can't see us, but we're fairly young, hip people, right? [Both laugh]

CV: Right.

DS: So, you know, that it shocked us, we're not, you know, old prudes. I mean, we, we saw this and thought, gosh I just cannot believe that this is happening, and is anyone talking about this. And really not a lot of people were aware that this is happening, or at least not in our world of academia. So we thought, let's explore what's really going on here, um, are there ethical issues that are popping up. I think, maybe our gut reactions were yes, there seems to be something a little off about these performances, about the way that women are being treated in these videos. And it's, you know, almost always this male surgeon with this female patient, and what are the kind of gender dynamics going on there. Um, so I want us to dig in to all that kind of stuff. But before we do, maybe we should just sort of set up what Snapchat is. So, if you're listening to this podcast you're probably super savvy on all the social media, but it's worth noting. So, you know, maybe we first had Facebook, um, which most people are aware of and apparently most people in the world belong to. Then we have Twitter, which is more, you know, sort of the talking points, we have Instagram which is more of the pictures, but then we get Snapchat, which – and you explained this to me and I actually didn't know it – what was the original intent of Snapchat?

CV: Yeah, so it's interesting. Snapchat was these guys who were college students at Stanford – not, they dropped out of Stanford once they developed, uh Snapchat. But they, the idea was that you could get your girlfriend or, or someone on campus that you wanted a naked selfie of, that they could send it to you and it would, the text message or the photo would self-destruct in a certain number of hours. Initially it was, you could sort of set how, how many hours it would be in existence before it would go away. And the story, and I don't know if it's apocryphal or not, was that one of the guys who developed this had sent a nude selfie of himself to someone and was regretting it and said, gosh, we should be able to figure this out so that these, we can have so much fun sending these sort of messages to one another, but then they would go away so it's not permanent. And they first called it "peek-a-boo" [Picaboo], which is why the Snapchat symbol is a ghost.

DS: Yeah, which makes a ton of sense. And I had never thought about that before, but I always thought, oh, why is there that weird ghost as its symbol, but-

CV: Yeah.

DS: -That's why. But Snapchat is huge, right, so, and it is expanded beyond the sort of, the initial purpose of sending nude selfies. It has gotten much bigger than that. They have news channels on it now, there's all sorts of, you know, things you can do with it. Um, so maybe can you explain some of that? I know it has a huge population of people that visit Snapchat. And who are those people?

CV: Well it's pretty interesting, about 25 percent of Snapchat users are under the age of 18. So, uh, and then the rest of them are over the age of 18, but really it's not, there's not a whole lot of Gen Xers really using it. But I think it's mostly Millennials and younger. And there's all kinds of crazy things that you see on there. A lot of models or tastemakers or influencers have Snapchat channels where they kind of document their life and show how fabulous they, they're being. Or there's, there's a gentleman who basically just is constantly broadcasting his life on Snapchat, everywhere he goes, and sort of just showing the way he lives his life. The interesting thing is that, you know I talked about that one surgeon that I had heard about, and then I, when I started looking at it more in-depth, there's all sorts of surgeons who are on there, uh, broadcasting their videos. It's not just a few. There's a large cohort, a growing cohort of people who are putting their operations on Snapchat, getting, um, because it's sort of interesting to watch. People really like to see this sort of thing I guess.

DS: I guess, because some of these guys have like a million followers, right?

CV: Right. Yeah.

DS: So, it is actually a large population of people who find like watching these surgeries really interesting. So, not, not sort of remote. I mean, we were like, we've never heard of this. But some of these guys have a million followers-

CV: Right.

DS: So it might have just been us that didn't realize that this was happening.

CV: Right.

DS: Yeah, and so, I guess what should be obvious, but maybe isn't at this point is that what makes Snapchat different than a lot of other social media is that there's very little filter on it. So there's a lot, there's not very much censorship so you can post nudes.

CV: Right.

DS: Where as most social media will prohibit that. So it can, they have rules against pornography, but I think what counts as pornography verses nudity is a little sort of sketchy. And that might influence how you sort of see these videos, because they're, they're nude women, usually. So, that's okay. And they're apparently not pornographic because surgeons are in the room? I think that's an open question about what constitutes pornography, right, but um, so something we can think about more.

CV: Yeah I think that's a really interesting point, because I think context matters. You know, surgeons, plastic surgeons in particular, are pretty used to objectifying the female body, medicalizing it, and thinking about it in, in medical terms. And so, for one plastic surgeon to show another plastic surgeon an image of a naked woman and discussing her breasts, that's sort of what plastic surgeons do. Why is that okay, and why is that not just two guys being gross? Well it's, it's because there's this idea that it's within the scope of their medical profession, and that, um, that somehow because we've taken these sort of professional oaths, and we hold ourselves to a certain standard, that we're not doing it in some nefarious way. That somehow you're doing this exchange of information between two surgeons, and it's for the benefit of the patient. Taking those same types of images and putting them in a different context, I think completely changes the meaning. And so, putting it in a context of sort of a jocular, you know, context where people are young and goofing around and, and potentially female bodies are being sexualized by other users of Snapchat, to have a surgeon putting those types of images in there I think changes the meaning and, and that's why it's not okay.

DS: Yeah, potentially. And so I think we should set the stage, cause I think this is really sort of hard to imagine, it immediately sounds sort of suspect, but I always tell people, it's worse than you think. Sort of whatever you had in your head. 'Cause I think a lot of us have maybe watched some reality television where there's surgery happening, which generally does try to keep it pretty professional and more or less true to what really goes on in the operating room. But, these videos are super stylized. So, to sort of set the stage, it's usually, I'd say a young-ish male surgeon with a cohort of young, pretty nurses, who are aiding him. Um, he'll usually give some sort of like cool monologue about all the cool stuff he's gonna do, um, I'd say there's sort of like a bro culture happening because the guys are always like, “oh yeah, I'm totally, it's totally going to be amazing, she's gonna look so great after I do this.” They'll frequently like break into dance, so all the, and all the nurses will sort of dance along. They'll sing, they'll, I've watched some of the surgeons like excise fat and sink it into a basketball hoop. I mean, it's just sort of very jocular, very, sort of, you know, it's a performance.

CV: Right.

DS: I don't know what, how else to describe it. And it's a very sort of particular performance that's meant to be fun. I think it's also maybe meant to be educational, or at least that's what they'll say. But mostly it's this like very stylized, like they are, the surgeon is the person who you're supposed to focus on, and he's putting on a performance for you so you know how great he is, and how fun plastic surgery is while he's doing it. Does that sound fair?

CV: Yeah, I think that's, that's one of the, you know, the complaints is that it makes it seem like it's all fun and games, and at whose expense? You know, there's a, there's a... I guess, I guess they're a willing patient. And we should talk about what, you know, because these patients apparently give consent, but, um, you know, in some sense it's hard to watch these without feeling that somehow the dignity of the patient is being cast aside, for sure. And, you know, the question's been raised, you know, is the safety of the patient being cast aside? And, is, or compromised in some way. And are, you know, in this performance, what is being conveyed to potential, to potential patients is that this is all just fun and games, there aren't, there can't possibly be any real risks to this if everyone's just having fun. And this is just a good time for everyone involved. When there really are significant risks of undergoing any kind of surgical procedure, particularly these sort of elective procedures. Which are done, you know, at the patient's behest.

DS: Yeah, I think that's a good point. So, it totally minimizes any sort of risk, because yeah, exactly, you wouldn't be dancing and singing and doing all this kind of stuff if there was real risk involved. Like these are professionals, they take oaths, you know, if it, if it were risky, you'd think they wouldn't act this way. But of course we know that's not true. I think the other element of this that, um, maybe is the most disturbing to me is just the way that the surgeons talk about women's bodies. So I think this is what struck me at first, is there's a lot of groping, there's a lot of like smacking of body parts, there's a lot of, um, you know, “she's gonna look so hot,” “she's gonna look so tight,” “her husband is gonna be so happy with the results of this.” So there's a lot of like sort of overt sexualizing of the body, which presumably was part of the reason that these patients went to the surgeon. So, you know, they wanted a certain body type. But, I get so uncomfortable when they talk about women's bodies this way. You know, they're, “look at that ass.” I mean, just, it's vulgar-

CV: Mm-hmm.

DS: Some of it is very vulgar. And it's the kind of, like you wouldn't allow a man to talk to a woman like that in public, you'd just sort of probably be disturbed by that. But because it's the surgeon and because the woman consented to this surgery and presumably wants this surgery, I don't know, do you think that makes is more okay?

CV: Uh, no. [Both laugh] I don't think it's okay, but I guess, then, you know, the charge to be leveled that I'm just, you know, a prudish person who lives in an ivory tower, that I'm out of touch with reality. But I think that, that, you know the surgeons, you know, for better or for worse, surgeons are allowed a lot of leeway and power in society. And to do these types of activities, I think is a, a misuse of the power and an abuse of the power. And what I think, what I think we're seeing is this sort of conflation of the male gaze that, you know, that, the idea that men sit around and stare at women's bodies, and project certain kinds of norms that they think are, you know are normative onto them from sort of a male perspective. That that's sort of being overlaid with the medical gaze, which again may or may not be appropriate depending on your point of view, but which occurs when physicians interpret the bodies of their patients in a medical way and describe them. You know that's something that happens all the time, and is something that often doesn't happen in public, or in a performative way, it actually usually happens behind closed doors between professionals. But what's I think jarring about seeing these videos is that there's this overlay of the two types of objectification of bodies, in a public way, that's also performative and clearly meant to entertain. I think, I like to use the term "medutainment" to describe what I think is going on, where it's really, clearly the intent is to entertain the viewer. Wink, wink, I'm educating you. The idea is that, you know, oh, of course we're just educating our patients and are educating the public on these types of things, and people really, you know, want that kind of knowledge, and, “aren't I a great person because I'm educating the public.” But really, it's just entertaining them, it's just for the shock and awe value. And, again, to utilize patients' bodies in that way, I think is transgressive.

DS: Mm-hmm. Yeah I love that the medical gaze, so Christian and I are both into Michel Foucault, right. So this idea that, and I think he was the first to introduce this, at least the phrase-

CV: Yeah.

DS: -That the doctor has to kind of look at their patient as an object, and you hear this when you, you know, you're in the hospital all the time. The patient with blah-blah-blah in room six, you know patients rarely get names. And, you know, some of that's distancing from how difficult it is to be a physician, but some of it really is just, I need to view my patient this way so that I can really get at the problem. And if I sort of have to conceptualize their whole humanity all the time, that makes my job potentially more difficult. And whether that's right or wrong, it is often how it works. But then you sort of layer that on with how men look, objectify women too, it gets a little sort of confusing, and I think both of, you're right, they're both happening here. And when we first started talking about this, I thought, gosh it's so much like the old freak show.

CV: Right.

DS: I used to teach a course on the history of the American freak show, and really what propelled the freak show, what made it socially acceptable in a society where it might not have been otherwise, was the alliance with scientists and physicians. Who would come and say, you know, it's okay to look at this person like this for, you know, you might think it's entertainment but it's actually not because you're learning about human bodies. So whether that person was from, you know, some remote country that no had ever met someone from that part of the world before, or they were unusually tall, or short, or fat, or skinny. I mean, this, when you add the sort of scientific perspective, it legitimizes it. And I think that's what's happening here too, is that if men were doing this outside of the profession of medicine, we would potentially find it unacceptable. But because they're educating us about what happens in surgery, and they have that professional clout, then we think it about, the context suddenly becomes very different. But, we now look back at the freak show and say, nope, that was probably inappropriate, whether or not physicians were attached. So maybe one day we'll look back on this and think the same? Or maybe this will just become kind of more par for the course, maybe this is sort of a fad that's not going away. What do you think?

CV: Well you know, when I talk to, I'm not a very popular person at plastic surgery meetings, because I, I'm kind of a downer when I talk about this and how I think it's a bad idea because I think in general, at our national plastic surgery meetings, there's all kinds of seminars that you can take about to be more effective on social media, how to build your brand, how to get more followers and viewers and all that sort of thing. And that there's, there's this celebrity culture it seems to kind of, people, more people want to be a part of it, including plastic surgeons. And so, you know, the statement's often been made to me that, you know, this is, there's no going, there's no turning back from this. And you can be ethical, as ethical and professional as you wanna be, but if you don't have a million followers on Instagram or Snapchat, you're gonna become irrelevant. And so, the thought is that this is where people live, they live in social media, and bringing knowledge to where the people are in the way that they want to hear it is what surgeons should be doing. Those are the arguments that I hear, and the pushback that I get, when I, at our sort of national level, have tried to address what I think is inappropriate behavior. People say, get with the times, there's really no going back, patients consent to this, so what's the big deal.

DS: Yeah, that's what I hear too. When, as soon as I sort of start to describe this people, people's first reaction is, well, are they consenting? Are these patients possibly consenting to this? And you say yes, I mean, people do presumably consent, I mean we're not in the room when that happens, but you'd think by now these guys would have been sued had these patients not consented to this.

CV: Right.

DS: So there, I think there's good reason to assume they are consenting, and that they do understand the stakes and the performance. Because a lot of these doctors will say that they get patients from this. Like most of their patients watch them on Snapchat first, and then ask for surgery. So, it's apparently so, it becomes so popular that they're allowed to then have a very select pool of people they'll perform these surgeries on, because they've become so popular. So it's certainly helping their bottom line, it's helping their practice. You know, whatever that says about our culture and, and what we want to participate in, it certainly is helping them. And maybe this is the future. I'm not sure I wanna say doctors aren't allowed to use social media, that seems too far. But at the same time, you have to be able to point out some of these practices and say, gosh, this seems really exploitative. This seems like we're pathologizing something about a woman's body that ought not to be. But it's kind of, it's slippery, it's hard to put your hands on exactly what is wrong here.

CV: Yeah, I think that there's two, I think we should come back and talk more about the pathologizing of bodies, but certainly I think that consent is necessary, but it's not sufficient for the ethical use of patients' images. Whether it's on a website or social media or a YouTube channel or Instagram account. That the surgeon owes it to their patient to not exploit them, and that even if a patient is sort of complicit in their own exploitation, that because, I would argue, that surgeons and any physicians are supposed to hold themselves to a higher standard of respect for the person who's trusting them with their body, that they're violating a professional norm. If you wanna say that it, maybe it's, you know some people might say, well don't, you can't say it's unethical, but certainly I would say it violates a professional norm of surgeons sort of showing respect to the body and not exploiting their patients or any physicians really shouldn't be exploiting their patients for their own benefit. And it's hard to argue that if the surgeons weren't benefiting from this, they wouldn't be doing it.

DS: Mm-hmm.

CV: So clearly it's to their benefit, and it's hard to understand what benefit the patient's getting from this. Maybe they're getting their 15 seconds of fame, but it's, it's hard to quantify that that's really worth it.

DS: Right. And I think we came to this sort of pathologizing insight because the majority of these surgeries are labiaplasties, right.

CV: Mm-hmm.

DS: So, this is a very popular Snapchat surgery, and, my guess is that maybe people don't even know what this is? So, can you just sort of briefly, what is a labiaplasty?

CV: Well so it's, it's actually interesting, the rise in labiaplasties in plastic surgery has gone up 40 percent in the past year. And I think it's even going up even more. So this is a thing where if your labia minora are slightly larger, you can have them sort of cut down to size. And so, often times when you see someone describing this, one of the things they'll say, “we're gonna give you a neat and tucked-in look so you don't have a loose sloppy look” or whatever. It's sort of awful, but essentially, and they also tout this as vaginal rejuvenation, which is sort of interesting when you think about normal labia, the labia minora hang outside the labia majora. And the look that's being preferred by patients who get this is that the labia minora are quote unquote “tucked-in”-side the labia majora. Which is the look of little babies, or what we call Tanner Stage 1. Which is sort of this classification system of how you describe someone and where they are in going through puberty. And so this idea of vaginal rejuvenation, you know, in concert with doing labiaplasties is making a Tanner Stage 4, which is a post-pubertal appearance, and kind of turning, quote turning back the clock, that's what plastic surgeons do best, we turn back the clock, and turning you back to a Tanner Stage 1 to give you the look of someone who hasn't gone through puberty. And so that's really a little upsetting when it's put that way, I think. But it's, but if you look at what these websites or what people post on their Snapchat—again you can't show this on Instagram, but guys will show this on Snapchat, because it's uncensored. You get the sense that normal genitalia, we're being told it looks abnormal and it needs to be changed and made better.

DS: Yeah. I think that was maybe the most shocking thing I learned, is that what women want apparently is, you know, labia that look like they're pre-pubescent. That is so, so disturbing. And certainly, the physician has a role in that, right? It wasn't, it's not just a bunch of women who've never heard of this coming to the doctor saying this is what I want. I mean, they're perpetuating this idea that they're within the range of normal variation, there is “good and bad,” “before and after,” “pre-pubescent post-pubescent,” and what we really want is this like pre-pubescent ideal, and you know, we could say that about of course a lot of plastic surgery and a lot of what women want.

CV: Yeah, you know, clearly I don't think, you know, not to downplay. Some people have, have problems where a labiaplasty is an appropriate operation. I have performed them, and so it's not that that's necessarily a bad operation. But, you know, I think that you have to think if, they're doing almost twice as many now as we were three years ago, it's not that there's been a rash of some horrible disease that's caused this. It's that perceptions about what's normal and abnormal have changed in society, and there may be a few factors that are, that are, have effected changing what is considered normal. But certainly one of those things is what's being shown on, in the venue of these social media outlets.

DS: Yeah. So, Christian, I mean, what, what do we do? We see this, and you and I and most people I've shown it to find it super disturbing. That the Snapchat performance is too much, right. So, we're not saying no social media, but we're saying these performances are exploitative, and damaging potentially to women’s psyches and their bodies. What's, how do we move forward?

CV: Well, that's interesting. I've, I've written some things for the plastic surgery literature, to try to establish some concrete guidelines where this would be clearly outside what's considered normal, so I've published that. I'm currently on the ethics committee of the American Society of Plastic [Surgeons], we're the ones who deal with complaints about this. So, if you see something like this and it bothers you, you can complain to the American Society of Plastic [Surgeons]. Or to the state licensing boards. And, you know, the, one of the hallmarks of the profession is that it's self-regulating. And so, I may be naive, but I think that what needs to happen is that this needs to be regulated more by the professions and by the physicians. It's gonna be difficult to regulate from a state or federal standpoint because it would, it's covered under free speech. You know, people claim, “well I'm just expressing my free speech, who cares if I'm exploiting people.” You know, at a, at a federal level or a state level it's hard to legislate that. But physicians are in charge of who gets to, you know plastic surgeons are in charge of who gets to be a plastic surgeon. You know, the American Board of Plastic [Surgeons] consists of other people like me who decide who's in and who's out. And so, I personally am working towards making it more difficult to be in if this is the way that you're gonna treat your patients. Now, I'm speaking primarily about these egregious cases that we've used. There's plenty of plastic surgeons who are on social media who are doing things in a respectful manner, and they're actually are improving communication and education. But there are these outliers that I think give, that leave a bad taste in our mouth, and that give us a bad name. Give plastic surgeons in general a bad name. So I'm hoping for the ability to improve regulation of this within plastic surgery.

DS: Yeah, that seems like the best way to move forward. So I am super glad that there are people like you [laughs], who are important enough in the profession to sort of set some standards. And so I guess we'll just have to sort of wait and see in the future if that's able to happen, and maybe the rest of us in the meantime could just be a little bit more suspect of what's going on here. You know, whatever voice we have, we're just gonna say, you know, this isn't how we want women to be treated, this isn't how we want surgeons to act, and, you know, we can voice that now and you can fix the problem for us. [Laughs]

CV: Yeah, I think the thing is too is that I show everyone I can. I mean, I subjected you to this [Devan laughs] when I said here take a look at this, this is awful, because I think that in some ways some of these surgeons live in an echo chamber, where they're surrounded by people who are telling them that this is really great. And if that's the case, then they're not hearing any voices of reason saying, you know, maybe you've crossed the line here. And so, having, you know, sensible people view this sort of thing and say is this really, is this really appropriate? Is this the way I want, do I want, you know, do I want my kids to open my Snapchat account and accidentally see something like this? You know, again, 25 percent of Snapchat users are under the age of 18, and there's a lot of naked bodies. So, you know, is that, is that what we want? Or do we want something that's, you know, a little bit safer for the viewers who are actually using it.

DS: Yeah. Absolutely. Well thanks, Christian, this was a really great conversation. And I, I thank you so much for your insight. And hopefully we'll put a link to our article and your other articles about social media-

CV: Sure.

DS: -With this podcast on our website. Thanks so much.

CV: Yeah, thank you.

LM: Thank you for joining us today on No Easy Answers in Bioethics. Please visit us online at bioethics.msu.edu for full episode transcripts and other resources related to this episode. A special thank you to H-Net: Humanities and Social Sciences Online for hosting this series. This episode of No Easy Answers in Bioethics was produced and edited by Liz McDaniel in the Center for Ethics. Music is by Antony Raijekov via Free Music Archive.